Abstract
Introduction
Tetraventricular hydrocephalus happens due to the fourth ventricle outlet obstruction.
Idiopathic fourth ventricle outlet obstruction (IFVOO) is a condition where no clear-cut
etiology for fourth ventricle outlet obstruction can be found. The etiopathogenesis
of IFVOO is unclear. There is no clear-cut consensus regarding the treatment practices
for its management. These cases present a diagnostic dilemma to the treating neurosurgeon
and are thus often managed inappropriately. This study aims to review the existing
literature regarding this condition, illustrating with a case from our hospital.
Case Details
We present a case of a 50-year-old female who presented to us with the chief complaints
of headache, difficulty in walking, with an inability to balance while standing and
walking, diplopia, and three episodes of loss of consciousness for 6 months. A brain
MRI was done, which was suggestive of dilatation of all ventricles with obstruction
at the foramina of Luschka and Magendie. She underwent a right-sided, medium-pressure
ventriculoperitoneal shunt at our hospital. Postsurgery, there was immediate improvement
in her symptoms.
Conclusion
IFVOO is a rare cause of tetraventricular hydrocephalus with an unknown cause. Endoscopic
third ventriculostomy (ETV) appears to have a higher risk of failure in such cases.
Fenestration procedures after craniotomy and shunt procedures are still effective
in their management. ETV is still an alternative to the above-mentioned procedures.
To confirm these conclusions, larger studies involving multiple hospitals and institutes
are required.
Keywords
idiopathic - fourth ventricle outlet obstruction - hydrocephalus - Luschka - Magendie
- endoscopic third ventriculostomy - foramina
